Provider Demographics
NPI:1245679257
Name:OGUNKUNLE, FLORENCE OLUFUNKE
Entity type:Individual
Prefix:MISS
First Name:FLORENCE
Middle Name:OLUFUNKE
Last Name:OGUNKUNLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1704
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29116-1704
Mailing Address - Country:US
Mailing Address - Phone:803-515-4617
Mailing Address - Fax:
Practice Address - Street 1:2037 SAINT MATTHEWS RD
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29118-2036
Practice Address - Country:US
Practice Address - Phone:803-515-4617
Practice Address - Fax:803-662-9207
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-24
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X, 374U00000X, 376J00000X
SC105765163WH0200X
SC14324376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No251E00000XAgenciesHome Health
No374U00000XNursing Service Related ProvidersHome Health Aide
No376J00000XNursing Service Related ProvidersHomemaker
No163WH0200XNursing Service ProvidersRegistered NurseHome Health